黄汉儒教授学术经验总结及壮医“湿毒”论治痛风的临床观察

发布时间：2018-01-11 22:22

本文关键词：黄汉儒教授学术经验总结及壮医“湿毒”论治痛风的临床观察　出处：《广州中医药大学》2016年博士论文　论文类型：学位论文

【摘要】：广西是壮族人口最多的少数民族地区,民族医药资源丰富,成就了不少治学严谨、医德高尚、医术精湛的民族医药大家。系统挖掘整理和传承广西名老壮医的学术思想和技术专长,不仅是为了传承他们的宝贵经验,而且有利于培养具有学术特色和技术专长的高层次民族医药人才。黄汉儒教授是我国壮医药学的主要创建者和学术带头人、壮医学理论体系的主要奠基人。在五十多年的临床诊疗和三十年的壮医药发掘整理研究工作中,形成了自己鲜明的学术思想和独特的诊疗技术,积累了丰富的临床经验。传承他的学术思想和技术专长,是壮民族医药薪火相传、创新发展的基石。本研究分为三大部分：黄汉儒教授学术思想渊源研究、黄汉儒教授学术思想和临床经验整理研究和壮医“湿毒”论治痛风的临床研究。一、学术思想渊源研究探析导师的学术渊源。主要对黄汉儒教授的成长经历、求学之路、事业成就、治学精神等人生历程以及祖国传统医学经典古籍、历代医家关于壮族医药的论述等方面进行溯源。探讨黄汉儒教授学术思想、临床经验形成的过程。通过分析导师学术渊源及成才之路,寻找继承其学术思想及临床经验的思路和方法。二、学术思想和临床经验整理研究目的：对黄汉儒教授学术思想和临床经验进行全面的整理与总结。方法：通过对黄汉儒教授临证医案、学术专著、公开发表论文等资料的整理,运用文献研究、回顾性分析等方法,对黄汉儒教授的学术思想、临证经验进行系统的疏理和研究。1.对黄汉儒教授壮医理论的整体学术思想进行概括阐述；2.对黄汉儒教授在运用壮医理法方药诊疗疾病过程中形成的学术观点、学术特色进行归纳总结；3.结合典型医案分析,分别从“痧瘴蛊毒风湿”、“三道两路”等各类壮医常见病对黄汉儒教授诊疗疾病的具体经验进行梳理,总结出黄汉儒教授运用壮医理法方药诊治疾病的方法特色和用药经验；4.采用回顾性分析法探讨黄汉儒教授治疗痛风的用药规律。5.对自己独立临床工作中治疗隆芡(痛风)、滚克(类风湿性关节炎)以及骆芡(多发性骨关节炎)等风湿性骨关节病的实践经验进行总结,传承导师经验,创新发扬。结果：1.黄汉儒教授首次提出“毒虚致病”的壮医病因病机论。黄汉儒教授临床上主张辨病与辨证相结合,以辨病为主；治疗上主张专病专方专药；提出“调气、解毒、补虚”的壮医治疗总则,提倡公母搭配的用药原则。2.分门别类的归纳总结了黄老诊治痧病、瘴病、湿病、气道病、谷道病、水道病、龙路、火路等壮医常见疾病的特色方法和经验用药。3.对118张痛风诊断处方的回顾性分析,筛选出黄老治疗痛风的核心药物,总结出黄老治疗痛风的基本方为：葫芦茶60g,金银花30g,见肿消15g,葛根20g,绞股蓝20g,薏苡仁15g,土茯苓10g,土牛膝15g,车前子10g,白术8g。4.在汲取黄汉儒教授风湿痹症的治疗经验的基础上,结合自己的临床实践,从辩证分型、治则治法、用药等方面总结了本人在治疗隆芡(痛风)、滚克(类风湿性关节炎)以及骆芡(多发性骨关节炎)3种风湿性骨关节病的临床经验。结论：黄汉儒教授有自己鲜明的学术观点和独特的诊疗技术,学生学以致用、继承发扬。三、壮医“湿毒”论治痛风的临床研究目的：以黄汉儒教授治疗痛风的经验为指导,从湿毒理论角度出发,自拟药方葫芦茶除湿解毒汤,并对该方治疗痛风进行临床研究,使黄汉儒教授治疗痛风的经验得以传承、创新。方法：60例痛风患者随机分成治疗组和对照组各30例。治疗组予葫芦茶除湿解毒汤治疗,对照组予双氯芬酸钠双释放肠溶胶囊等药物治疗。观察两组治疗前后相关生化指标血尿酸(SUA)、C反应蛋白(CRP)、血沉(ESR)以及安全性指标的检测、关节肿痛指数评价、关节疼痛VAS评分和中医症候评分等的变化,对葫芦茶除湿解毒汤治疗痛风的临床疗效进行综合评价。结果：①对实验室指标的影响：治疗组SUA治疗后比治疗前显著降低(P0.01),治疗组降低SUA的作用明显优于对照组(P0.01)；治疗组CRP治疗后比治疗前明显降低(P0.05),治疗组的抗炎作用与对照组等效(P0.05)；治疗组ESR治疗后比治疗前显著降低(P0.01),降低红细胞沉降率的作用明显优于对照组(P0.01)。②对症状体征的影响：治疗组疼痛VAS评分治疗后比治疗显著前低(P0.01),但在缓解疼痛方面作用稍逊于对照组(P0.05)；治疗组关节肿痛积分治疗后比治疗前显著降低(P0.01),治疗组缓解关节炎症的作用与对照组等效(P0.05)；两组关节肿痛指数比较差异无统计学意义(PO.05),说明两组在控制关节炎症方面效果相似；治疗组关节功能评分治疗后比治疗前显著降低(P0.01),在改善关节功能方面与对照组等效(PO.05)；治疗组中医证候评分治疗后比治疗前显著减低(P0.01),改善中医证候的作用优于对照组(P0.01),治疗组中医证侯积分指数明显高于对照组(P0.01)。③综合疗效：治疗组总有效率93.3%,对照组总有效率82.1%,两组总有效率相似(P0.05);经Ridict分析,治疗组综合疗效优于对照组(P0.01)。④药物安全性：治疗组药物对安全性指标影响不大,不良反应发生率为0,明显优于对照组。结论：治疗组在改善痛风的症状和体征方面能够达到对照组的效果,治疗组的降低尿酸作用明显优于对照组。葫芦茶除湿解毒汤能够避免西药产生的不良反应,同时又能有效提高痛风患者的临床症状缓解率。
[Abstract]:Guangxi is the Zhuang population of minority areas most, ethnic medicine is rich in resources, a lot of achievements in scholarship, noble medical ethics, the skills of the national medicine. All academic and technical expertise system to excavate and inheritance of Guangxi old Zhuang medicine, not only to pass on their valuable experience, but also conducive to the cultivation of high level national medical talents with academic and technical expertise. Professor Huang Hanru is the main founder and academic leaders in China's strong medicine, the main founder of Zhuang medicine theory. In the clinical diagnosis and treatment of more than 50 years and thirty years of Zhuang medicine excavated in the research work, formed their own distinctive academic thoughts and unique treatment technology, has accumulated rich clinical experience. Inheritance of academic and technical expertise is his, Zhuang nationality medicine generation, foundation of innovation development. This research is divided into Three parts: Analysis on Professor Huang Hanru's academic ideological origins, academic thought and clinical experience of Professor Huang Hanru collation and study of Zhuang medicine "damp" theory. A clinical study on the treatment of gout, academic origin, academic ideological origins of tutor. Mainly on Professor Huang Hanru's growing experience, study the road of achievement, the spirit of learning life and the course of traditional Chinese Medicine Classics, ancient physicians about Zhuang medicine and other aspects of traceability. Discusses the academic thoughts of Professor Huang Hanru, the process of clinical experiences. Through the analysis of teacher academic origin and the road to success, find the ideas and methods of inheriting the academic thought and clinical experience. Two, academic thought and clinical experience of finishing Objective: To study on the academic thought and clinical experience of Professor Huang Hanru to conduct a comprehensive review and summary. Methods: Based on Professor Huang Hanru clinical medicine, The academic monographs, published papers and other information collection, the use of literature study, retrospective analysis, Huang Han Dynasty Confucians professor's academic thoughts and clinical experience of research professor Huang Hanru.1. on the whole theory of Zhuang medicine academic thoughts are summarized; 2. of Professor Huang Hanru formed in the use of strong medical method medicine treatment of the disease process of the academic point of view, the academic characteristics are summarized; 3. with typical case analysis, respectively, from the "cholera poison miasma rheumatism" "three, two other types of Zhuang medicine common disease diagnosis and treatment of diseases of Professor Huang Hanru specific experience to sort out, summed up the characteristics of method used by Professor Huang Hanru Zhuang Medical Law medicine for the treatment of disease and medication experience; 4. by retrospective analysis of Professor Huang Hanru in the treatment of gout medication of.5. on their own independent clinical therapy of lung thickening (gout) Roll, G (rheumatoid arthritis) and Luo Qian (multiple bone arthritis) are summarized such as rheumatic osteoarthrosis experience, inheritance of tutor's experience, develop innovation. Results: 1. "was first proposed by Professor Huang Han Dynasty Confucians Zhuang medicine etiology and pathogenesis of deficiency of toxic pathogenic" on clinical professor Huang Hanru. Claim on combination of disease and syndrome differentiation, to identify disease treatment claims; special disease medicine; put forward the "Regulating Qi, detoxification, general treatment of Zhuang medicine tonic",.2. medication to advocate the principle of male and female collocation summing up be arranged Huang Lao Sha of diagnosis and treatment of disease, malaria, rheumatism, airway Valley Road disease, disease, disease of channel, long road, a retrospective analysis of 118 gout diagnosis prescription characteristics method and experience of drug.3. common diseases fire Lu Zhuang medicine, selected core drugs in the treatment of gout of Huang Lao, summed up the basic treatment of gout: old yellow gourd tea 60g, honeysuckle 30g, See the BZX 15g, Pueraria 20g, Gynostemma 20g, coix seed 15g, Poria 10g, Eupatorium 15g, Plantago 10g, Atractylodes 8g.4. based treatment experience in drawing on Professor Huang Hanru rheumatism, combined with clinical practice, from the dialectical type, treatment, medication and other aspects summarized my in the treatment of lung thickening (gout), roll g (rheumatoid arthritis) and Luo Qian (multiple bone arthritis) clinical experience of 3 rheumatic osteoarthropathy. Conclusion: Professor Huang Hanru has its own distinctive academic viewpoint and unique treatment technology, students learn to use, inherit and carry forward the three., "damp" theory of Zhuang medicine: clinical study of antipodagric by professor Huang Hanru in the treatment of gout experience as a guide, from the perspective of the theory of damp, prescription bottle gourd tea chushijiedutang, and clinical research on the treatment of gout, gout to Professor Huang Han Confucianism treatment experience In succession, innovation. Methods: 60 cases of gout patients were randomly divided into treatment group and control group with 30 cases in each group. The treatment group received gourd tea chushijiedutang treatment, control group received Diclofenac Sodium Dual Release Enteric-coated Capsules drug treatment. Two groups were observed before and after treatment of related biochemical indicators of blood uric acid (SUA), C reactive protein (CRP), erythrocyte sedimentation rate (ESR) and safety index test, evaluation of joint swelling index, joint pain changes VAS score and TCM syndrome score, to evaluate the clinical efficacy of gourd tea chushijiedutang gout treatment. Results: the effect on laboratory index: the treatment group SUA after treatment decreased significantly than before treatment (P0.01) SUA, the treatment group decreased significantly than the control group (P0.01); the treatment group CRP after treatment were significantly lower than those before treatment (P0.05), anti-inflammatory effects in the treatment group and the control group (P0.05); equivalent treatment group after treatment of ESR Bridge Before treatment was significantly decreased (P0.01), erythrocyte sedimentation rate decreased significantly than the control group (P0.01). The influence of signs and symptoms: the treatment group VAS pain score after treatment than before treatment was significantly lower (P0.01), but the pain relief effect was slightly lower than the control group (P0.05); joint treatment group swelling and pain scores after treatment decreased significantly than before treatment (P0.01), the treatment group to relieve joint inflammation and equivalent control group (P0.05); there was no significant difference between the two groups in joint pain index (PO.05), indicating that the two groups in the control of joint inflammation effect similar to treatment group; joint function score after treatment than before treatment significantly decreased (P0.01), to improve the joint function and the equivalent control group (PO.05); treatment group of TCM syndrome score after treatment than before treatment significantly decreased (P0.01), improve the TCM syndrome effect is better than that of the control group (P0.01), the treatment group of TCM symptoms Integral index was significantly higher than the control group (P0.01). The comprehensive curative effect: treatment group total effectiveness 93.3%, control group total effective rate was 82.1%, the total efficiency of two groups was similar (P0.05); Ridict analysis of comprehensive effect in treatment group than in control group (P0.01). The drug safety: the treatment group had little effect on the drug the safety index, incidence of adverse reactions was 0, significantly better than the control group. Conclusion: the treatment group to the control group in improving the symptoms and signs of gout effect, reduce uric acid was significantly better than the control group. The treatment group gourd tea chushijiedutang can avoid the adverse reaction of medicine, but also can effectively improve the the remission rate of clinical symptoms in patients with gout.

【学位授予单位】：广州中医药大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R249;R29

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